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Understanding Breakthrough Pain and Flares

Drugs Designed for Breakthrough Pain

For a drug to be effective in treating breakthrough pain, it should be:

  • Fast-acting.
  • Flexible enough to get you through the flare, but not much longer.
  • Easy to take.

Short-acting and ultra short-acting drugs to relieve breakthrough pain are available in a variety of forms:

  • Tablets taken by mouth.
  • A lozenge on a handle. This medication dissolves through mucus membranes in the mouth to provide rapid pain relief.
  • A film that dissolves when placed on the inside of the cheek.
  • Injection.
  • Sublingual (under the tongue).
  • Nasal spray.

Over-the-Counter Pain Relief Options

Ibuprofen and naproxen sodium, known as nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen are over-the-counter medications used to treat mild breakthrough pain. Some might argue that breakthrough pain is never mild, but OTC medications shouldn’t be totally dismissed. They might work for some people. Doctors occasionally recommend their use in combination with prescription pain drugs to:

  • Provide a synergistic (combination) effect.
  • Stagger the timing of pain relief drugs.
  • Reduce the amount of narcotics being taken during a relatively short time period.

Side effects of NSAIDs may include upset stomach, nausea, vomiting, heartburn, headache, diarrhea, and/or constipation.

Prescription Medications for Breakthrough Pain

If pain is moderate and not responding to nonsteroidal anti-inflammatory drugs, opioid medications may be used. Opioid medication can be combined with NSAIDs or acetaminophen. Drug options may include oxycodone, hydrocodone, codeine, and others.

For moderate to severe pain, opioid medications are prescribed at higher doses. Medication options may include morphine, fentanyl, oxycodone, and hydromorphone.

Side effects of opioid medications may include drowsiness, nausea, vomiting, dry mouth, and/or constipation. Be sure to talk with your doctor about any side effects you may experience from any medication.

Getting Through a Flare

You can take action to get through a flare that does not necessarily involve hospitals or drugs. Here are some suggestions:

  • Talk with your doctor about the difference between a flare and pain that might need a closer look. Most chronic pain patients know (too well) the difference.
  • Make a list of things that appear to cause flares and when they occur. A pain diary will allow you to discuss the problem in detail with your doctor.
  • Keep an action plan close by in case BTP occurs. The plan might include a change in activities, relaxation or distraction techniques, reminders to use heat or cold applications, or guidelines for short-term changes in medications.
  • Remind yourself that flares are going to happen and rarely call for more tests or visits to the doctor.

Know Your Options

There is a lot about breakthrough pain that we don’t know, but advances in breakthrough pain management are encouraging.

“People who experience breakthrough pain should know that there are good treatment options available,” Shaparin says. “They should get regular evaluations and treatment from their primary care doctor first and then, if needed, from a board-certified pain medicine physician.”

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Reviewed on June 27, 2011

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